BC USMLE Step 2 Pediatrics _Ka

BC USMLE Step 2 Pediatrics (Kaplan) Study online at quizlet.com/_dlhlx 1.

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Normal Vital Signs Newborn RR HR SBP DBP

RR-40-60 HR-120-160 SBP-65 DBP-50

Conjunctivitis Cause: Day 1Day2-7>7 Days>3 weeks-

Day 1- chemical irritation Day 2-7- Neisseria gonorrhea >7 DaysChlamydia trachomatis >3 weeks- herpes

What Dx of Newborn: X-linked, hemolytic crises. Tx?

G-6-PD Tx: reduce oxidative stress and special diet

What Dx of Newborn: AR, mental retardation, deficiency in enzyme phenylalanine hydroxylase

PKU Tx: special diet low in phenylalanine for first 16 years

What Dx of Newborn: mental and developmental retardation, inability to breast feed, inability to metabolize galactose

Galactosemia Tx: cut out all lactose

What Dx of Newborn: Cretinism

Congenital hypothyroidism Tx: replace hormone

What Dx of Newborn: multiple AR disease resulting in errors of steroidogenesis

Congenital adrenal hyperplasia Tx: replace mineralocorticoids and glucocorticoids

Palmar Grasp Presents: Disappears:

Presents: birth Disappears:2-3 months

Rooting Presents: Disappears:

Presents:birth Disappears: 48 hrs extreme constipation rectal exam shows extremely tight sphincter, can't pass flatus

Hirschprung Disease AXR-distended bowel loops Manometry high pressure anal sphincter Dx-full thickness biopsy showing lack of ganglionic cells

VACTERL

V-vertebral anomalies A-anal atresia C-cardio anomalies T-TEF E-esopageal atresia R-renal anomalies L-limb anomalies

What is Dx? bilious vomiting within 12 hours birth CXR-double-bubble

Duodenal atresia a/w annular pancreas and Down Syndrome 1st step - IVF

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Painless rectal bleeding

Meckel's diverticulum Best test-technetium 99 scan aka Meckel scan

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Findings in IDM-5

1) Macrosomia- enlarged organs except brain, polycythemia 2) Small Left Colon Syndromedescending colon 3) Cardiac abnormalitiesasymmetric septal hypertrophy 4) Renal Vein Thrombosis 5) Metabolic changes -hypoglycemia-szrs -hypocalcemia-tetany, lethargy -hypomagnesemia-hypocalcemia and PTH disease -hyperbilirubinemia-icterus and kernicterus

Findings in 17-alpha hydroxylase deficiency Aldosterone: Cortisol: Sex hormone: BP: Sxs: Electrolytes:

Aldosterone:increase Cortisol:decrease Sex hormone: decrease HTN Sxs: female-normal @ birth, delayed puberty male-pseudohermaphrodite Electrolyes-hypokalemia

Findings in 21hydroxylase deficiency Aldosterone: Cortisol: Sex hormone: BP: Sxs: Electrolytes:

Aldosterone:decrease Cortisol:decrease Sex hormone:increase BP: hypotension Sxs: female-look male, internal female male-normal @ birth Electrolytes-hyponatremia, hypochloremia, hyperkalemia

11-beta hydroxylase deficiency Aldosterone: Cortisol: Sex hormone: BP: Sxs: Electrolytes:

Aldosterone:decrease Cortisol:decrease Sex hormone:increase 11-DOC-increase (weaker aldosterone) BP: HTN Sxs: female-virilized male- normal @ birth Electrolytes:no change

Vit D. deficiency CalciumPhosphate1-25 Vit. D25 Vit. D-

Calcium- Normal or decreased Phosphate-decreased 1-25 Vit. D-decreased 25 Vit. D-decreased

Vit. D dependency CalciumPhosphate1-25 Vit. D25 Vit. D-

Calcium-decreased Phosphate-normal 1-25 Vit. D-decreaed 25 Vit. D-normal

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X-linked hypophosphatemia

Calciumnormal Phosphatedecreased 1-25 Vit. Dnormal 25 Vit. Dnormal

What is Dx? chorioretinitis, hydrocephalus, ringenhancing lesions on CT

Toxoplasmosis

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Dx test Toxo

Initial-IgM Best- PCR

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Tx Toxo

Pyrimethamine and Sulfadiazine

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What is Dx? rash on palms, soles, snuffles, frontal bossing, Hutchinson 8th nerve palsy, saber shins/teeth

Syphillis

Dx test Syphilis

Initial-VDRL or RPR Best- FTA ABs or dark field micro Penicillin

What is Dx? PDA, cataracts, deafness, IUGR, blueberry muffin rash, hyperbili, hepatosplenomegaly

Rubella

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Dx test Rubella

Maternal IgM

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Tx Rubella

Supportive

What is Dx? periventricular calcifications with microcephaly, chorioretiinitis, hearing loss, petechiae

CMV

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Dx test CMV

initial-urine or saliva titers best- urine or saliva PCR for viral DNA

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Tx CMV

Ganciclovir

What is Dx? week 1-shock and DIC week 2- vesicular lesions week 3-encephalitis

Herpes

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Dx test Herpes

Initial- Tzanck Best-PCR

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Tx Herpes

Acyclovir and supportive

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Tx Syphilis

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What is Dx? pruritic vesicular rash beginning on face, fever, malaise

Varicella

What is Dx? cough, coryzam conjunctivitis with Koplik spots on buccal mucosa

Measels/Rubeola (paramyxovirus)

What is Dx? fever and URI progressing to rash "slapped cheek" appearance

Fifth disease/Erythema infectiosum (Parvovirus B19)

What is Dx? Fever and URI progressing to diffuse rash

Roseola (Herpes 6 and 7)

What is Dx? fever precedes parotid gland swelling with possible orchitis

Mumps (paramyxovirus)

What is Dx? Barking cough Coryza Inspiratory Stridor Hypoxia

Croup -parainfluenza virus 1 and 2, RSV

What is Dx? Fever Drooling in tripod position "hot potato" voice refusal to lie flat

Epiglottitis H. influenza type B. (Stept and staph too) 3-7 year olds

Tx Epigottitis

Ceftriazone 7-10 days Intubate if severe Rifampin to close contacts

What is Dx? severe coughing episodes with extreme gasps for air followed by vomiting

Whooping Cough Bordetella pertussis

Tx Whooping Cough

Erythromycin or Azithromycin (only in catarrhal stage) isolate child Macrolides to close contacts DTaP vaccine-herd immunity important

What is Dx? gray pseudomembrane plaques on pharyngeal wall.

Diptheria Corynebacterium diptheriae DO NOT SCRAP Tx-antitoxin, ABX don't work

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What is Dx? Painful limp, 2-8 year old XR? Tx?

Legg-Calve-Perthes Dx avascular necrosis of femoral head XR-widening and effusions of joint Rest and NSAIDs, then surgery on both hips

What is Dx? Painful lump and externally rotated leg XR? Tx?

Slipped capital femoral epiphysis, displacement/shift of growth plate common in obese adolescent XR-widening of joint space Tx-internal fixation with pinning